Extent of coronary atherosclerosis and arterial remodelling in women: The NHLBI-sponsored women's ischemia syndrome evaluation

Stephen J. Nicholls, E. Murat Tuzcu, Kathy Wolski, B. Delia Johnson, George Sopko, Barry L. Sharaf, Carl J. Pepine, Steven E. Nissen, C. Noel Bairey Merz

Research output: Contribution to journalArticleResearchpeer-review

2 Citations (Scopus)


Background: Information regarding the pathogenesis of ischemic heart disease (IHD) in women is limited. Sex-specific responses to atherosclerosis and coronary arterial remodelling in women versus men have been hypothesized, but limited study exists. Methods: Case-matched study of 174 women with suspected ischemia referred for coronary angiography: 87 with non-obstructive coronary artery disease (CAD) (no luminal diameter stenosis >20% in any coronary artery) and 87 age and ethnicity matched women with obstructive CAD. Groups were compared with regard to atheroma burden and coronary arterial remodelling assessed by coronary artery intravascular ultrasound (IVUS). Results: IVUS revealed more extensive atheroma with obstructive CAD vs. those without obstructive CAD, with greater percent atheroma volume (PAV) (36.1%±9.8% vs. 25.4%±9.1%, P<0.0001), total atheroma volume (TAV) (140.8±58.7 vs. 98.8±46.9 mm3, P<0.0001) and percentage of images containing plaque (70.0%±30.5% vs. 35.7%±32.6%, P<0.0001). Adjusting for risk factors, PAV (35%±1% vs. 28%±1%, P=0.0008), TAV (131±7 vs. 115±7 mm3, P=0.110) and percentage of images containing plaque (66%±4% vs. 45%±5%, P=0.0008) remained greater with obstructive CAD. Obstructive CAD was associated with smaller lumen volumes (251.9±92.8 vs. 289.7±91.8 mm3, P=0.005), but surprisingly, the external elastic membrane (EEM) volume was very similar comparing the groups (392.7±128.1 vs. 388.6±113.7 mm3, P=0.910). Conclusions: Our findings suggest that women referred to angiography for suspected ischemia, have differing patterns of coronary arterial response to injury with regard to accumulation of atherosclerosis and compensatory remodelling related to the presence and absence of obstructive CAD. Preservation and cultivation of compensatory arterial remodelling may be a novel CAD therapeutic target.

Original languageEnglish
Pages (from-to)405-413
Number of pages9
JournalCardiovascular Diagnosis and Therapy
Issue number4
Publication statusPublished - 1 Aug 2018
Externally publishedYes


  • Adverse coronary remodelling
  • Coronary intravascular ultrasound (coronary IVUS)
  • Ischemic heart disease in women (IHD in women)
  • Non-obstructive coronary artery disease (non-obstructive CAD)

Cite this